Peuskens J
The Catholic University of Leuven, University Centre St. Jozef, Kortenberg, Belgium.
Curr Med Res Opin. 2002;18 Suppl 3:s23-8. doi: 10.1185/030079902125001092.
The introduction of atypical antipsychotics represents an important advance in the treatment of schizophrenia. As their therapeutic efficacy, tolerability and safety profiles are clearly superior to classical neuroleptics, atypical antipsychotic agents are considered to be the treatment of choice in first episode patients. In addition, an increasing number of patients are being switched from classical to atypical antipsychotic agents. Switching is especially relevant in patients with a poor therapeutic response to classical neuroleptics and persistent symptoms (positive symptoms, negative symptoms, depressive syndromes, cognitive deficit); in patients with a psychotic relapse despite compliance; in patients with important side-effects (not only acute and tardive extrapyramidal symptoms [EPS] and general side-effects, but also dysphoria or neuroleptic-induced deficit syndrome [NIDS]); and in patients who are non-compliant due to side-effects. Switching to atypical antipsychotics should be performed with extreme care in stabilised patients; or in patients who present a danger to themselves or others at relapse; or in patients who are on depot neuroleptics who were non-compliant to previous oral treatment. Switching requires careful planning to reduce the risk of withdrawal effects (neuroleptic withdrawal syndrome, cholinergic rebound, exacerbation of symptoms or relapse, rebound of parkinsonism, dystonia, akathisia, dyskinesia), which may mask the beneficial effects and lead to early discontinuation of the new treatment. Patients, family and carers should be actively involved at all stages, and educated about the possible benefits and problems associated with switching therapy. Cross-tapering old and new treatment is the preferred method for switching and this involves tapering off the previous antipsychotic agent and any adjunctive treatment (sedatives, anticholinergic medication), while gradually titrating the new atypical antipsychotic agent to the established therapeutic dose. Switching patients to amisulpride treatment offers effective antipsychotic therapy, with a positive effect on negative and depressive symptoms. Amisulpride treatment also results in improved quality of life and social functioning in addition to fewer relapses and days of hospitalisation during long-term follow-up.
非典型抗精神病药物的引入是精神分裂症治疗的一项重要进展。由于其治疗效果、耐受性和安全性明显优于传统抗精神病药物，非典型抗精神病药物被认为是首发患者的首选治疗药物。此外，越来越多的患者正从传统抗精神病药物转换为非典型抗精神病药物。转换在以下患者中尤为重要：对传统抗精神病药物治疗反应不佳且症状持续（阳性症状、阴性症状、抑郁综合征、认知缺陷）的患者；尽管依从治疗仍出现精神病复发的患者；有重要副作用（不仅是急性和迟发性锥体外系症状[EPS]及一般副作用，还有烦躁不安或抗精神病药物所致缺陷综合征[NIDS]）的患者；以及因副作用而不依从治疗的患者。在病情稳定的患者中；或在复发时对自己或他人构成危险的患者中；或在使用长效抗精神病药物但对先前口服治疗不依从的患者中，转换为非典型抗精神病药物时应极其谨慎。转换需要精心规划，以降低撤药效应（抗精神病药物撤药综合征、胆碱能反跳、症状加重或复发、帕金森综合征反弹、肌张力障碍、静坐不能、运动障碍）的风险，这些效应可能掩盖有益效果并导致新治疗的早期中断。患者、家属和护理人员应在所有阶段积极参与，并接受关于转换治疗可能的益处和问题的教育。交叉逐渐减少新旧治疗药物剂量是转换的首选方法，这包括逐渐减少先前的抗精神病药物及任何辅助治疗（镇静剂、抗胆碱能药物），同时将新的非典型抗精神病药物逐渐滴定至既定治疗剂量。将患者转换为氨磺必利治疗可提供有效的抗精神病治疗，对阴性和抑郁症状有积极作用。氨磺必利治疗还可改善生活质量和社会功能，此外在长期随访中复发次数和住院天数减少。
